Risk Factors of Developing Postinfectious Irritable Bowel Syndrome in Shigellosis Patients, 5 Years After Hospitalization During the Outbreak.

Background: Irritable bowel syndrome (IBS) can be triggered by bacterial dysentery. This study aimed to investigate postinfectious IBS and its risk factors after the shigellosis outbreak in hospitalized patients. Methods: This retrospective study was conducted in 2020-2021 in referral hospitals for Shigella gastroenteritis during the 2014 shigellosis outbreak in Isfahan. The Shigella-infected group included hospitalized shigellosis patients with clinical symptoms and positive stool culture. The control group included patients matched pairwise on age and sex to the Shigella-infected group, admitted to the same hospitals in the same period with diagnoses other than shigellosis. Both groups had no history of diagnosed IBS before the outbreak. The incidence of IBS (according to Rome-III criteria) and its related factors was compared between the 2 groups 5 years after infection. Results: Of 619 participants, 220 (35.5%) were in the Shigella-infected group. The 5-year incidence of IBS was 31.8% and 5.7% in the Shigella-infected and control groups, respectively. Multivariate analysis showed that shigellosis was significantly associated with increased risk of IBS (odds ratio [OR], 17.18 [95% confidence interval {CI}, 9.37-31.48]). Multivariate analysis indicated education level (OR, 4.15 [95% CI, 1.47-11.73]), diarrhea lasting >4 days (OR, 1.69 [95% CI, 1.17-2.44]), and abdominal cramps during the infection (OR, 0.27 [95% CI, .77-.95]) associated with postinfectious IBS (P < .05). Conclusions: Hospitalized patients with Shigella gastroenteritis are at increased risk of IBS within 5 years after infection. Factors such as higher education level and the absence of abdominal cramps and diarrhea persisting for >5 days during hospitalization can further increase this risk.

Correlation between Success Rates of Cardiopulmonary Cerebral Resuscitation and the Educational Level of the Team Leader; A Cross-Sectional Study.

OBJECTIVES: To determine the correlation between the success rates of the cardiopulmonary cerebral resuscitation (CPCR) and the team's leader education and skill level in Shiraz, southern Iran. METHOD: This cross-sectional study was conducted during a 6-month period from October 2007 to March 2008 in Nemazee hospital of Shiraz. We included all the patients who underwent CPCR due to cardiopulmonary arrest in emergency room of Nemazee hospital during the study period. We recorded the rates of return of spontaneous circulation (ROSC) and discharge rate (DR) of all the patients. The correlation between these two parameters and the team leader's education and skill level was evaluated. RESULTS: Overall we included total number 600 patients among whom there were 349 men (58.1%) and 251(41.8%) women with mean age of 58.9±42.6.  We found that 270 (45.1%) patients had ROSC, while 330 (54.9%) patients died. Overall 18 (6.6%) patients were discharged   from hospital (3% of all participants). We found that the ROSC was significantly higher in those with specialist leader (anesthesiologist or pediatrician) when compared to those in whom CPCR was conducted by technicians (55.2% vs. 30.7%; p=0.001). CONCLUSION: Conducting CPCR by persons with higher medical degrees resulted in higher rate of ROSC but not in more discharge rate. Inspite of the fact that the rate of ROSC following CPCR was closely analogous to that of developed countries, discharge rate was lower. This indicates that in our region, much more attention needs to be paid to post-resuscitation care and organizing training programs and to cover more resuscitation by CPCR team, conducted by the specialists.

Thrombotic Thrombocytopenic Purpura associated with Clopidogrel: a case report and review of the literature.

Thrombotic Thrombocytopenic Purpura (TTP) is a life threatening, multisystem disease characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurological changes, renal failure, and fever. These signs and symptoms are thought to be caused by microthrombi, composed of agglutinated platelets and fibrin, which deposit in the arterioles and capillaries without mediation by an inflammatory process. TTP can occur in the first two weeks of initiation of Clopidogrel therapy. Early signs of TTP may be a skin reaction, which may precede the onset of TTP or it may be other type of purpura or neurological changes. We report the clinical and laboratory findings in a 67 years old female patient in whom TTP developed soon after treatment with 40 mg/day oral Clopidogrel after 8 days. She developed thrombocytopenia (platelets count 12000 /mm3). Her clinical signs and symptoms were fever (39.6C), bleeding from the nose and gum, large skin bruises (purpura and ecchymoses), neurological changes including hallucinations, bizarre behavior, altered mental status (fluctuating), headache, and renal dysfunction. Physicians should be aware of the possibility early onset of this syndrome when initiate Clopidogrel treatment.